warm up
What are the 2 ASA standards associated with Anesthesia Handoff?
What are standards 7 (anesthesia plan implementation and management) and Standard 11 (transfer of care)
(slide 5)
Shortly after extubation, you notice your patient exhibiting paradoxical breathing pattern, decreased oxygen saturation, and visible chest retractions. Despite increasing oxygen flow via a non-rebreather mask, the patient’s oxygen saturation continues to drop, and he appears to be struggling to breathe.what is most likely the cause?
what is Loss of pharyngeal muscle tone - Upper airway obstruction
can be from the effects of residual NMB, opioids, and/or IV or inhaled anesthetics.
(slide 14)
A 55-year-old woman is undergoing a total knee replacement under general anesthesia. The patient has a history of obesity and hypertension. During the procedure, her blood pressure drops from 120/80 mmHg to 70/45 mmHg (MAP 50 mmHg). The anesthesia provider notes that the patient has been receiving propofol and has been on a moderate dose of opioids. Additionally, the patient has received 500 mL of normal saline during the procedure.
Given the patient's history and current situation, which of the following actions is most appropriate to manage the hypotension?
A. Administer a bolus of 500 mL of crystalloid solution
B. Increase the dose of propofol
C. Administer 5 mg of ephedrine IV
D. Administer 1-2 units of vasopressin IV
C. Administer 5 mg of ephedrine IV
(slide 29)
rationale: patient is experiencing hypotension likely due to a combination of factors, including possible vasodilation from anesthetics and opioids. Given the moderate amount of fluid resuscitation already administered, a vasopressor like ephedrine, which increases systemic vascular resistance, would be a more appropriate initial intervention to address the hypotension.
Which of the following is a common cause of residual neuromuscular weakness in the PACU?
A) Adequate reversal of neuromuscular blocking agents
B) Aminoglycoside antibiotics
C) Increased muscle strength
D) Effective pharyngeal muscle function
B) Aminoglycoside antibiotics
(slide 34)
What is the recommended management approach for refractory post-operative nausea and vomiting (PONV)?
A. Increase the dose of the current antiemetic
B. Utilize a different antiemetic agent
C. Increase the amount of intravenous fluids
D. Delay the use of antiemetic medications
B. Utilize a different antiemetic agent
(slide 40)
What is the most common cause of post-operative arterial hypoxemia and what is the treatment?
What is Atelectasis, treatment: O2, cough, IS, increased mobility, smoking cessation 6-8 weeks.
(slide 13)
What is the most appropriate initial treatment for a patient experiencing Negative Pressure Pulmonary Edema?
a) Diuretics and sodium restriction
b) Supplemental oxygen and CPAP
c) Immediate bronchodilator therapy
d) Surgical intervention
b) Supplemental oxygen and CPAP
(slide 23)
Which antihypertensive medications should be discontinued on the day of surgery?
ACE-Inhibitors, ARBs
(slide 31)
Which of the following is NOT a criterion for adequate awake extubation?
A) Spontaneous, regular respirations
B) Sustained head lift
C) Vital capacity at least 2/3rd of baseline
D) Absence of pharyngeal muscle weakness
D) Absence of pharyngeal muscle weakness
(slide 35)
Which medication is specifically mentioned for preemptive management of postoperative shivering?
A. Propofol
B. Meperidine
C. Robaxin
D. Valium
B. Meperidine 12.5mg
(slide 42)
During the postoperative handoff, a patient exhibits shallow, rapid respirations, SpO2 < 90%, and is becoming increasingly restless. What is the most likely respiratory issue occurring?
a) Pulmonary embolism
b) Aspiration
c) Hypoxemia/Hypercarbia
d) Atelectasis
c) Hypoxemia/Hypercarbia
(slide 11)
Which of the following is NOT a component of Virchow's triad, which contributes to the risk of pulmonary embolism?
a) Venous stasis
b) Hypercoagulability
c) Alveolar hypoventilation
d) Abnormalities of the blood vessel wall
c) Alveolar hypoventilation
(slide 24)
Which of the following are common causes of perioperative hypertension? (Select all that apply)
A. Pain
B. Hypercarbia
C. Hypoglycemia
D. Bladder or bowel distention
E. Emergence delirium
F. Hypovolemia
A. Pain, B. Hypercarbia, D. Bladder or bowel distention, E. Emergence delirium
(Slide 30)
The treatment for emergence delirium includes all of the following EXCEPT:
A) Propofol
B) Precedex
C) Increased sedation with opioids
D) Environmental modification
c) Increased sedation with opioids
(slide 36)
Select all that apply for the goals of a multimodal approach to recovery:
A. Pain control for early ambulation
B. Immediate use of opioid analgesics
C. Early enteral nutrition
D. Attenuation of post-operative stress response
E. Avoidance of patient and family education
A) Pain control for early ambulation, C) Early enteral nutrition, D) Attenuation of post-operative stress response
(Slide 43)
What is the most common cause of postoperative arterial hypoxemia?
a) Pulmonary edema
b) Atelectasis
c) Aspiration
d) Pulmonary embolism
b) Atelectasis
(Slide 13)
What pathophysiological process is responsible for the development of Negative Pressure Pulmonary Edema after relief of severe upper airway obstruction?
a) Hypercoagulability
b) Increased pulmonary hydrostatic gradient
c) Decreased interstitial pressure due to laryngospasm
d) Excessive secretion production
b) Increased pulmonary hydrostatic gradient
(slide 21)
extreme negative intrapleural pressure--> increase in pulm. hydrostatic gradient--> cause a rapid fluid movement from the pulmonary vasculature to the interstitium/into the lungs. --> leads to flooded alveoli.
What would you expect to see on an ECG in a patient with hypokalemia?
A. Shortened QT interval
B. Prolonged PR interval
C. Widening of the QRS complex, U wave, and ST abnormalities
D. Elevated ST segment
C. Widening of the QRS complex, U wave, and ST abnormalities(slide 32)
Which of the following can prolong awakening due to metabolic disturbances?
A. Hypothyroidism
B. Electrolyte disturbances
C. Prolonged anesthesia
D. Drug interactions
B. Electrolyte disturbances: Alterations Sodium, Calcium and Magnesium can prolong awakening
(slide 37)
In Phase II of post-anesthesia care, which personnel requirement is correct?
A. Only one RN is needed
B. Two competent personnel are required, with at least one being an RN
C. One RN and one LPN are required
D. Only a physician is required
B. Two competent personnel are required, with at least one being an RN
(slide 46)
What should be done if severe airway edema is suspected after multiple intubation attempts?
a) Extubate the patient immediately
b) Administer IV fluids
c) Perform a leak test and delay extubation if necessary
d) Increase the depth of anesthesia
c) Perform a leak test and delay extubation if necessary
(slide 16)
Which of the following is a primary cause of hypoventilation?
A. Increased central respiratory drive
B. Enhanced alveolar ventilation
C. Poor respiratory muscle function
D. Excessive reversal of neuromuscular blocking drugs
C. Poor respiratory muscle function
(Slide 26)
Which of the following are potential causes of bleeding in the postoperative period? (Select all that apply)
A. Inadequate surgical hemostasis
B. Underlying hematologic condition
C. Chronic kidney disease
D. Coagulopathy after massive transfusion
E. Drug overdose
F. Disseminated intravascular coagulation (DIC)
A. Inadequate surgical hemostasis, B. Underlying hematologic condition, D. Coagulopathy after massive transfusion, F. Disseminated intravascular coagulation (DIC)
How does hypothermia affect platelet function during surgery?
A. It decreases bleeding by enhancing platelet aggregation
B. It increases bleeding due to platelet inhibition
C. It improves drug metabolism
D. It prevents prolonged effects of NMB
B. It increases bleeding due to platelet inhibition
(slide 41)
Select all that apply for conditions that may lead to fast-tracking from the OR to Phase II:
A. Use of local or regional anesthesia
B. Ambulatory or same-day admission
C. Complex surgical procedures
D. Criteria determined by an interdisciplinary care team
E. Age alone
A) use of local or regional anesthesia, B) ambulatory or same-day admission, D) criteria determined by an interdisciplinary care team.
(slide 47)